The space under the digital health umbrella resembles a crowded beach In the Summertime – apps for behavioral health, obesity, and diabetes dominate the early-to-market solutions. On the app store, there are over 10,000 apps for behavioral health alone- how is a consumer to decide that a makes a good app? This thought has dominated several papers I have included in past blog posts.
A new paper in Nature Digital Medicine by Andrew Carlo and colleagues from the University of Washington adds to our body of knowledge; regarding behavioral health mobile apps. The authors address several layers; including the breath of apps found in the Google Play and iTunes stores- the primary path consumers have for purchasing apps. They cover three app evaluation frameworks, including ORCHA- the Organization for the Review of Health Care Applications, PsyberGuide, and Mindtools.io.
This study looked at the top 25 behavioral health apps and their respective ratings in the app store. The frameworks also view apps through the lens of scientific credibility that being marketing claims vs. actual science base, transparency- whether the app companies are explicit about data use and data collection, Additionally they examine the apps’ user experience – is the app complying with MARS (mobile app rating scale) for intuitive user design? The frameworks hail from the USA, the UK, and Australia, so they bring a global perspective.
Overall, findings reflect a very mixed picture for the top 25 most downloaded behavioral health apps. Many make claims that are not borne out by the evidence base for mindfulness-meditation or cognitive behavioral therapy and offer little more than marketing claims to support their solution. Also concerning was the mixed picture for transparency and security regarding data use in an era when trust has eroded to all-time lows ensuring responsible data use is a critical opportunity area for the future. Lastly, apps live and die on whether you open them or not, the broader literature suggests people stop using most apps within two weeks- the MARS score was also underwhelming with many of the apps scoring in the subpar range. It may also be worth noting that the app frameworks themselves may not be sufficient or comprehensive to support high-quality decision making- the fact this field is evolving so rapidly and a score achieved may change a lot over time as apps release new versions with higher frequency to gain market share.
Many are waiting to see how the FDA pre-cert Software as Medical Device will evolve in the US markets but many apps developers will go directly to consumers in within Apple and Google’s platforms, so a method to support and inform consumer choice is nascent and necessary. Much work awaits us as consumers and health systems navigate the digital health space but these studies provoke dialogue and help us formulate better approaches to support improved health via digital pathways.
Thanks for reading – Trina
(Opinions are my own)
By the numbers: ratings and utilization of behavioral health mobile applications. https://www.nature.com/articles/s41746-019-0129-6
PsyberGuide App Framework from the USA
ORCHA from the UK
Mindtools.io from Australia